From today's NY times

March 22, 2006

Hi,

Does this sound familiar?

(article)

March 22, 2006

Op-Ed Contributor

The Doctor Will See You for Exactly Seven Minutes

By PETER SALGO

WHEN politicians speak of America's health care needs, they

often miss an important point: the doctor-patient relationship has

become frayed. Patients aren't unhappy just because health care

costs too much (though they would certainly like it to be more

affordable). Rather, people sense a malaise within the system

that has eroded the respect they feel patients deserve.

There has been a shift in attitude within the profession. I see

examples of it every day. I was making rounds in my intensive

care unit recently when one of the interns presented a case.

" This is the first admission for this 55-year-old male, " he said.

" Stop, " I said. " He is a man. "

" That's what I said, " the intern replied.

" Not exactly, " I answered. Clearly, the intern didn't get it. Neither

do a lot of other health care professionals anymore.

The problem has been sneaking up on us for almost two

decades. As health-care dollars became scarce in the 1980's

and 90's, hospitals asked their business people to attend

clinical meetings. The object was to see what doctors were

doing that cost a lot of money, then to try and do things more

efficiently. Almost immediately, I noticed that business jargon

was becoming commonplace. " Patients " began to disappear.

They were replaced by " consumers. " They eventually became

" customers. "

This may seem a trivial matter, but it is not. You treat " patients "

as if they were members of your family. You talk to them. You

comfort them. You take time to explain to them what the future

may hold in store. Sometimes, that future will be bleak. But you

assure them you will be there to help them face it.

You treat " customers " quite differently. Customers are in your

place of business to purchase health care. You complete the

transaction such a relationship suggests: health care for money.

And then they aren't your customers any more. Taken a step

further, you can make the case that the less time you spend with

your customers, the better your bottom line will be. This gets

everyone's attention.

" Length of stay " became a buzz phrase in hospitals in the

1990's. So did " throughput, " an awful neologism for the number

of patients per hospital bed per week. One of my colleagues

joked that a hospital stay was a lot like a taxi ride. The institution

collected a big fee when a patient got admitted, just as a cab

driver saw most of his fare when he first turned the meter on.

The additional money collected over time wasn't nearly as

impressive as that initial charge. The economics of the situation

favored short trips, or lengths of stay, and lots of new riders, or

throughput. The arithmetic worked, but I didn't notice a lot of

people laughing.

Doctors in hospitals all over the country began hearing the same

business language and facing the same pressures to " keep

things moving. " I used to be asked how well my patients were

doing. Suddenly administrators were asking how long I was

planning on keeping sick people in the intensive care unit. Each

day a patient spent in my unit was a day some other paying

patient would have to wait for a bed. Eventually, I was warned,

some of those patients " in orbit " would go elsewhere, and we

would not only " lose their business, " but we risked losing future

referrals from other centers.

It wasn't just hospitalized patients who were taking up space

other " customers " could use. Outpatients " consumed " health

care " resources, " too. Publicly traded H.M.O.'s, for example,

began restricting doctors to an average seven-minute

" encounter " with each customer. This apparently kept

shareholders happy. But it reduced the doctor-patient

relationship to a financial concept in a business school term

paper.

Doctors know you cannot provide compassion in seven-minute

aliquots. But we have felt powerless to change things. The

medical establishment has, many of us feel, simply rolled over

and gone along to get along. It has sacrificed patients' best

interests on the altar of financial return.

This leaves the solution to the problem in the hands of our

patients. You, the patient, are the system's best hope. In the age

of seven-minute health care, you need to realize that you employ

doctors. That is, your doctor works for you. Although doctors

shouldn't think of patients as customers, you can, and should,

adopt a business mind-set when shopping for health care.

Evaluate what it is you expect from your doctor, then ask for it. If

you are unhappy with your doctor, fire him. If you cannot get more

than a seven-minute face-to-face encounter with your doctor, he

needs fewer patients. The true power in the health care economy

rests not with the doctors and certainly not with the backroom

business staff. It rests with you. If you insist on being treated with

care and respect, you will be. And the system will improve as a

result.

A pediatrician I know put it quite succinctly. " There are a lot of

doctors in town, " she said. " There's no need to settle for one that

doesn't treat you well. "

In one respect the business people are right. Restoring the

doctor-patient relationship will not save anyone any money. But I

submit that it doesn't have to. There are other ways to curtail

health care costs. Some involve high technology; others do not.

None of them requires patients to sacrifice their self-respect.

We can and must reduce health care expenses. But we cannot

do it at the expense of patients' well-being. The doctor-patient

relationship is critical to the integrity of the health care system. It

is not disposable. Turning doctors into shopkeepers who regard

patients as customers is unacceptable.

How will the M.B.A.'s and the politicians respond to what can only

be termed a " patient-driven revolution " ? They will have to cope. I

suspect doctors will be thrilled.

Salgo, a professor at the Columbia University College of

Physicians and Surgeons, is an internist and anesthesiologist,

as well as the host of the PBS series " Second Opinion. "

March 22, 2006

That is a good article, but 7 minute, we should be so lucky.

My daughter has been seeing an Opthamologis5 retina specialist for several

years. He has always done her well. She lives 800 miles away. Because of this my

sister went to him. She lives a 2-hour drive away so with both these extra

effort was required. His time with patients got progressively shorter although

he did spend more time with my daughter. The last apt. my sister had I checked

my watch as he opened to door to enter, and again when he left. ...less than 60

seconds. Is it any wonder she doesn't see him anymore? He had changed nurses and

she was with another doctor in the same group. She changed because she did not

think he was treating his patients fairly. Oh yea, my daughter now sees a doctor

that is 700 miles closer to her.

BVan (Betty)

[ ] From today's NY times

Hi,

Does this sound familiar?

(article)

March 22, 2006

Op-Ed Contributor

The Doctor Will See You for Exactly Seven Minutes

By PETER SALGO

March 22, 2006

we definetly travel to get more time with docs in our family. It taks me 5

hours to drive my son to his retina specialist. It is worth every second of the

drive. Sady since Oct we have had to go once a week. (and we have had 2

surgeries, my so had a severe traumatic eye injury, he is 10)

We drive 2 hours to go to a Shriners CHildrens hospital for heterotopia and

shortened cords, our local ped said were a product of my imagination, but

SHriners confirmed via MRI etc and now treat. They then went so far as to

coordinate visits so we see 3 specilasts there now for him and they set our

appts at days and times so we can see all 3 specialist the same day (and we did

not have to ask for this)

We drive 3 hours to see a psychiatrst, therapist, and neurologist combo for my

oldst child who is bipolar and has PDD and my son who has seizures and brain

damage.....and they offer us email contact unlimited, appts whenever we

want....will spend over an hour with us....our local nes would only set up 10

min appts, nd yes, how up late, leave early and tell us to direct questions to

the receptionist.

And I just posted about a new rheumy I saw yesterday who spent 3 full hours with

me on my first visit. He offered me a 24 hour 7 day number I can call ANYTIME.

I am not sure I saw my old rheumy for a total of 3 hours in the last 5 years,

and no, I did not ever get a 24 hour number. Yes, I will drive to him,

too.....7 minutes? no thanks. How much info can a doc gather in 7 mins? how

can a patient understand much in 7 mins?

- In , " Betty " <bvanOmega@...> wrote:

>

> That is a good article, but 7 minute, we should be so lucky.

>

> My daughter has been seeing an Opthamologis5 retina specialist for several